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Complications Post Liver Transplant
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Complications Post Liver Transplant

My mom had a living donor liver transplant back in January 2010 in China. in 2013 she started her HCV treatment and since they she has been un-detected for HCV (HCV free).  She did pretty good after the transplant for about ~3 years. In December 2013, we took her to a reputable hospital in NC (liver transplant center) and they diagnosed her with liver rejection and found ascites in her abdomen.
In the events/months that followed they did several liver biopsies (Biopsy show Stage 2 Fibrosis) and have found two strictures in the Portal Veins (which they opened by stents) a stricture in the bile duct (also opened by a stent). Despite all this her ascites kept coming back and her overall health worsened. In the start her ascites was red but then changed to white but recently has changed to red again.
In July 2014 she went through a Abdomen Laproscopy to find out the cause of the ascites but the team found nothing. She came out with SBP post surgery which they treated with antibiotics.
Several MRI, CT Scans, Ultrasounds and Cancer Screening Markers tests were conducted but nothing was found.
Her ascites contained high levels of lymph and therefore the doctors suggested we do a Lymph angiogram. The lymph angiogram found a blockage in her lymph vessels. They put her on a fat free diet. Within 2 weeks of the fat free diet her Biliruben started to shoot up. They did an ERCP and found a stenosis in the bile duct and put a stent in there. At this point her ascites had started turning red from white again.
Recently the hematologists have asked for another biopsy and another venogram which was conducted last Friday. The vengoram showed high portal pressure but the biopsy showed Stage 2 Fibrosis and an early evidence of bridging fibrosis.
She has been HCV free for about 18 months. She has had no history of acute rejection.

Questions to the doctors on this forum is (especially Dr Sachiano) what do you think is going on here? Here AST is 60, ALT 30, Biliruben two month ago was 1 but now is ~19.
The hepatologist has maintained her Tac levels at 3 to 4 (0.5 mg ONCE a day).
5 Comments Post a Comment
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317787_tn?1373214989
Hi I am so sorry to hear your Mom is having problems.  
I wish there was a doctor here.
What did your Mom treat her HCV with?
I am asking because you mentioned her bilirubin was high.
If you can let me know I will try to search for some answers for you.
Take Care
Dee
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317787_tn?1373214989
Hi I found this, not sure it will help.  I wish we had doctors here, we have not had any since the summer.
Medhelp is working on it.

http://www.medhelp.org/posts/Liver-Transplant/bilirubin/show/1586564
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Avatar_f_tn
She got treated with interferon and riboflavin for 6 months. She has had multiple HCV test that all came back negative.

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Avatar_m_tn
Very difficult issues for both her and you. Did they measure her HVPG before and after the resolution with her portal vein strictures? And do they think that surgery had anything to do with those strictures?
.
Clearly things are inconsistent with stage-2 from the liver biopsy but with chronic ascites present. Keep in mind her liver damage may likely be patchy so the biopsy sample may have simply missed the more troubled zones. If it's not an obvious portal vein thrombosis or anything downstream obstructing the hepatic vein, then her liver is suspect. Just wondering if the previous stricturing has caused some liver patchy liver damage. That should be visible though in an dynamic contrast enhanced MRI.

Wishing good luck and keep us informed.
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317787_tn?1373214989
Hi I am glad to hear that your Mom was able to kill the virus, that is very good news.
There is another forum where people help each other, it is called the cirrhosis forum,  there are a lot more people there. Some have had transplants and they are very knowledgeable.
I hope you can find an answer, please keep in touch

http://www.medhelp.org/forums/Cirrhosis-of-the-Liver/show/1390
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